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Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study.
Eur J Pediatr. 2018 Jan; 177(1):79-84.EJ

Abstract

There is evidence pointing to a decrease of the glomerular filtration rate (GFR) in a subgroup of nephrotic children, likely secondary to hypovolemia. The aim of this study is to validate the use of urinary potassium to the sum of potassium plus sodium ratio (UK/UK+UNa) as an indicator of hypovolemia in nephrotic syndrome, enabling detection of those patients who will benefit from albumin infusion. We prospectively studied 44 nephrotic children and compared different parameters to a control group (36 children). Renal perfusion and glomerular permeability were assessed by measuring clearance of para-aminohippurate and inulin. Vaso-active hormones and urinary sodium and potassium were also measured. Subjects were grouped into low, normal, and high GFR groups. In the low GFR group, significantly lower renal plasma flow (p = 0.01), filtration fraction (p = 0.01), and higher UK/UK+UNa (p = 0.03) ratio were noted. In addition, non-significant higher plasma renin activity (p = 0.11) and aldosteron (p = 0.09) were also seen in the low GFR group.

CONCLUSION

A subgroup of patients in nephrotic syndrome has a decrease in glomerular filtration, apparently related to hypovolemia which likely can be detected by a urinary potassium to potassium plus sodium ratio > 0.5-0.6 suggesting benefit of albumin infusion in this subgroup. What is Known: • Volume status can be difficult to assess based on clinical parameters in nephrotic syndrome, and albumin infusion can be associated with development of pulmonary edema and fluid overload in these patients. What is New: • Urinary potassium to the sum of urinary potassium plus sodium ratio can accurately detect hypovolemia in nephrotic syndrome and thus identify those children who would probably respond to albumin infusion.

Authors+Show Affiliations

Department of Paediatrics, Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. keenswijkwerner@yahoo.com.Department of Paediatrics, Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.Department of Paediatrics, Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.Department of Paediatrics, Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.Department of Paediatrics, Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

29022080

Citation

Keenswijk, Werner, et al. "Urinary Potassium to Urinary Potassium Plus Sodium Ratio Can Accurately Identify Hypovolemia in Nephrotic Syndrome: a Provisional Study." European Journal of Pediatrics, vol. 177, no. 1, 2018, pp. 79-84.
Keenswijk W, Ilias MI, Raes A, et al. Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study. Eur J Pediatr. 2018;177(1):79-84.
Keenswijk, W., Ilias, M. I., Raes, A., Donckerwolcke, R., & Walle, J. V. (2018). Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study. European Journal of Pediatrics, 177(1), 79-84. https://doi.org/10.1007/s00431-017-3029-2
Keenswijk W, et al. Urinary Potassium to Urinary Potassium Plus Sodium Ratio Can Accurately Identify Hypovolemia in Nephrotic Syndrome: a Provisional Study. Eur J Pediatr. 2018;177(1):79-84. PubMed PMID: 29022080.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study. AU - Keenswijk,Werner, AU - Ilias,Mohamad Ikram, AU - Raes,Ann, AU - Donckerwolcke,Raymond, AU - Walle,Johan Vande, Y1 - 2017/10/11/ PY - 2017/06/19/received PY - 2017/09/29/accepted PY - 2017/09/10/revised PY - 2017/10/13/pubmed PY - 2018/6/16/medline PY - 2017/10/13/entrez KW - Acute kidney injury KW - Aldosterone KW - Hypovolemia KW - Nephrotic syndrome KW - Plasma renin activity KW - Urinary potassium to urinary potassium plus sodium ratio SP - 79 EP - 84 JF - European journal of pediatrics JO - Eur. J. Pediatr. VL - 177 IS - 1 N2 - : There is evidence pointing to a decrease of the glomerular filtration rate (GFR) in a subgroup of nephrotic children, likely secondary to hypovolemia. The aim of this study is to validate the use of urinary potassium to the sum of potassium plus sodium ratio (UK/UK+UNa) as an indicator of hypovolemia in nephrotic syndrome, enabling detection of those patients who will benefit from albumin infusion. We prospectively studied 44 nephrotic children and compared different parameters to a control group (36 children). Renal perfusion and glomerular permeability were assessed by measuring clearance of para-aminohippurate and inulin. Vaso-active hormones and urinary sodium and potassium were also measured. Subjects were grouped into low, normal, and high GFR groups. In the low GFR group, significantly lower renal plasma flow (p = 0.01), filtration fraction (p = 0.01), and higher UK/UK+UNa (p = 0.03) ratio were noted. In addition, non-significant higher plasma renin activity (p = 0.11) and aldosteron (p = 0.09) were also seen in the low GFR group. CONCLUSION: A subgroup of patients in nephrotic syndrome has a decrease in glomerular filtration, apparently related to hypovolemia which likely can be detected by a urinary potassium to potassium plus sodium ratio > 0.5-0.6 suggesting benefit of albumin infusion in this subgroup. What is Known: • Volume status can be difficult to assess based on clinical parameters in nephrotic syndrome, and albumin infusion can be associated with development of pulmonary edema and fluid overload in these patients. What is New: • Urinary potassium to the sum of urinary potassium plus sodium ratio can accurately detect hypovolemia in nephrotic syndrome and thus identify those children who would probably respond to albumin infusion. SN - 1432-1076 UR - https://www.unboundmedicine.com/medline/citation/29022080/Urinary_potassium_to_urinary_potassium_plus_sodium_ratio_can_accurately_identify_hypovolemia_in_nephrotic_syndrome:_a_provisional_study_ L2 - https://dx.doi.org/10.1007/s00431-017-3029-2 DB - PRIME DP - Unbound Medicine ER -